Frequency and risk factors of resistant gram negative bacterial infections in Dokuz Eylül Üniversity Hospital intensive care unit

SUMMARY RISK FACTORS AND FREQUENCY OF RESISTANT GRAM NEGATIVE INFECTIONS IN ADULT INTENSIVE CARE UNIT Purpose: Gram-negative bacteria (GNB) are associated with approximately 25% of BSIs in intensive care units (ICU). The most common GNB isolated in hospital-acquired BSIs are P.aeruginosa, Acinetobacter species, K.pneumoniae, and Enterobacter species and result in prolonged hospitalization, higher economic burden, and increased mortality. We performed a retrospective cohort study to evaluate the epidemiology of resistant GNB (P aeruginosa, A baumannii, and K pneumoniae), bacteriologic and clinical outcome of infections, all-cause mortality, and risk factors associated with adverse outcome in critically ill adult patients of a medical ICU. Methods: Patients were identified by electronic search of the hospital laboratory database (blood, tracheal aspiration and urine cultures positive for resistant GNB). All adult patients hospitalized in the ICU at Dokuz Eylül University Hospital, from September 2013 to October 2014, who developed infection because of MDR GNB (during ICU hospitalization) were enrolled. Patients who died in the ICU during the first 24 hours were excluded. Results: A total of 80 patients with infection because of MDR GNB was identified and were matched for the case-control study with 200 controls. The number of patients who infected with resistant GNB was 80, the number of patients noninfected with resistant GNB was 200. In evaluated patients, A.baumannii, K.pneumoniae and P.aeuroginosa were the most resistant GNB, respectively. In patients who infected with A.baumannii, there was no sensitive A.baumanni strains. and all of A.baumannii strains were susceptible to colistin. APACHE II score, time of mechanical ventilation, length of ICU stay and length of hospital stay were independent risk factors for resistant GNB. Mechanical ventilation and use of central venous catheter were related with increased mortalite rates. Central venous catheter and length of ICU stay were independent risk factors for resistant A.baumannii. Long mechanical ventilation day, long hospital stay and long ICU stay were common risk factors for resistant K.pneumoniae and P.aeuroginosa. As different from P.aeuroginosa, use of TPN was a risk factor for resistant K.pneumoniae and K.pneumoniae's mortalite rate was higher than A.baumanii and P.aeuroginosa. Result: In ICUs, obey to the rules for sterilization, hand hygien and disinfection, use of devices like santral venous catheter for only apropriate indications, refrain from long hospital stay and long ICU stay as much as possible were necessary. In addition, patients traced with mechanical ventilator should be seperated from the ventilator as soon as possible and parenteral nutrision products should not be used instead of enteral nutrision if it's not necessary. First of all, to prevent the development of resistance, a great care must be shown for the use of antibiotics and antibiotics must be used for correct indications. Key words:Resistant gram negative bacteria,drug resistance,intensive care unit.